Provider Demographics
NPI:1558504225
Name:DAGENHART, TRENA L (RN)
Entity Type:Individual
Prefix:MRS
First Name:TRENA
Middle Name:L
Last Name:DAGENHART
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TRENA
Other - Middle Name:L
Other - Last Name:HIRSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4507 HALIBUT POINT RD # B
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-9507
Mailing Address - Country:US
Mailing Address - Phone:907-966-3419
Mailing Address - Fax:
Practice Address - Street 1:222 TONGASS DR
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-9416
Practice Address - Country:US
Practice Address - Phone:907-366-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK25999163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care